Breast Cancer Treatment Choices - part 2

A woman who has been diagnosed with cancer, from a biopsy, then will see a surgeon who specializes in breast cancer. Surgery to remove the tumor is always needed, as long as the tumor is in the breast it will grow and chances are the cancer cells will travel away from the main tumor and spread throughout the body. These cells that move away from the main tumor will settle and grow into tumors in other parts of the body, not just the breast. The surgeon will ask questions about the woman's health and ask about the woman's family. If a woman has family members that have, or have had breast cancer, this information will be included in treatment decisions. The surgeon then will discuss ways to treat the cancer. A mastectomy which is a removal of the breast that has the cancer in it, with one or more lymph nodes removed is one choice. A lumpectomy which is removal of the cancer tumor and a small amount of tissue surrounding the tumor is another choice. The size of the tumor, determined by the mammogram, will influence these choices. If the tumor is large a lumpectomy may not be a good choice. The smaller the tumor, the better the chances of survival for the woman. The larger the tumor the more involved the surgery will need to be, such as a mastecomy. Sometimes chemotherapy is needed before surgery; the chemotherapy will hopefully shrink the tumor and kill cancer cells that may have moved away from the main tumor (metastasized). When this is done before the surgery, the hope is that after surgery most or all of the cancer will be gone and only radiation will be needed. Chemotherapy may be needed after surgery depending on the type and stage of the cancer.

Often the surgeon will ask a woman to see a radiation oncologist before her surgery. This consultation will allow the radiation oncologist, another cancer doctor who specializes in radiation, to review the woman's case and to offer choices of treatment. The options this doctor may offer are whole breast radiation after surgery, or partial breast radiation after surgery, or no radiation if a woman has a mastectomy and no cancer cells are found outside the breast that was removed in surgery.

One type of partial breast radiation is brachytherapy. Breast brachytherapy has been available for some time, but not all doctors are familiar with it. Brachytherapy of the breast is a good choice for some women. The size of the tumor and the location of the tumor are two of the determinations if this is a good choice. If the cancer is found out side of the breast, brachytherapy is not a choice for a woman. Brachytherapy is radiation given to the area where the cancer tumor was. This is where most cancers come back, in the same area they were to begin with. Brachytherapy can be given over five days, where as whole breast radiation if given over 6 weeks. This is an advantage for women who do not live near a cancer treatment center, women who live busy lives (most women do), or women who don't want to prolong their treatments. When a woman chooses breast brachytherapy the applicator that will allow radiation to go right into the space where the cancer was; is placed at the time of surgery. Brachy means close. It is another advantage of brachytherapy. Only the tissue around where the cancer tumor was is radiated; the normal tissue is exposed either not at all or to such a low level of radiation it is not affected by the radiation.